General Permits (5980)

n ll",
Y CERTIFICATION OF EXEMPTION G f (-Op
FROM REQUIRING A CAMA PERMIT "
as authorized by the State of North Carolina, 4-
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Phone Number
Address J
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
State
Zip _
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE: )
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
f
1 .
Applicant's sign re
CAMA Official's signature
Issuing date
Expiration date
I
Attachment: 15 North Carolina Administrative Code 7K .0203 I

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JAN-12-99 TUE 02:20 PM LORA M BYRD
FAX:[phone] PAGE 5
AAJA.C]NT>,,,-w.,YARL4N PROPERTY OWN STATEMENT
I hereby certify that I own propety adiacent to G--L e:� ��4rZz2� 's
(Fame of. Prnperty Owner)
proY loca-tedat��Aa5'r
-'(Lot, Block, Read, etc.)
I
on �a�c a v,�: Al` Po Q �i9--�"�-rZ c�t"_6y' ZL_ N.C.
— --
(Waterbody) (Town. andlor County) - -- —'
He has described 0 me.as-shown below, the development he is prIIp;Sa,
and; I have ao objections to h,,- prupasai,.
DESCRU`TQN- IOR DRAWING OF PROPOSED f?�,V"sr•,�.r �.:
i T
_ �� be f'ed i.x by 4z&v&ud1 proposing deveioprazp?x,
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ft�/c JAN 2 6 1999
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Print or Type dame
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Telephone Number
Date_ �)_Ta)q u A / 9 9 9
01/12/99 15:22 TX/RX N0.0164 P.005
11

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property ae:'jacent to I-L t�:-M �A2 i o� Is
(Name of Property Owner)
property located at 3►-�1 ���} e(Lotso�t C I �cL'�
- , Bloc , Road, etc.) --- 9
on 9 06 u t�- �� U�� in JOW Po(L7
(Waierbody) - (Town and/or County) ' " t
He has described to me.-as.sh.own below, L< a development he is proposing aft at' �:ty.n
and; I have no objections to lus prop?
DESCRIP QN-AjND/OR .DR `;fir. N OF PROPOSED DEVELOP�-�E
(To be , faded &u by h-,div&j,.fzl proposing development)
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L�2Cr�
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JAN 26 1999
Signature --- _— --
Print or Type Name
z 793 F a
Telephone Number
.Tate:

FJAC;�y-�, �.IP
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pROP�
- T'Y p� SZ'A
a
r hey ce
f that I own ProPe-'ty adiac=t to
ProPerty locatedat f', L4ct P 4 es o (Name ofAa _ 10"j ,5
Perty pWaerj
on UOGv� �I+��, R �9 Rnad, e�
Sv v� )
(tiYater�od_v} is
h�-wPa2 T �� C
ge has described (Town an or
- -� tvn oeiow
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i I have -no 0• . , twe ae'ieioprn=t he Is
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j le•.„ ttons to h:� .cup,;; PmPo dap
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P� rP05
,vl PasoN , 3 4q 3 5-5 Pts.Dc; JAN 2 6 1999
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